We read with interest the report by Bais et al1 describing 2 familial cases combining features of autosomal dominant polycystic kidney disease and genetically confirmed Alport syndrome (AS). While the clinical narrative is compelling, their discussion omits our recent cohort study,2 the largest to date (n = 257 with 990 exome-negative controls), which found no significant association between AS and multiple kidney cysts. Our findings argue against integrating multiple kidney cysts within the AS spectrum.